ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1622777
This article is part of the Research TopicReal-World Clinical and Translational Research in Gastrointestinal CancersView all 12 articles
Comparative study of National Institute of Health criteria and TNM staging system in predicting the prognosis of gastrointestinal stromal tumours: A retrospective study
Provisionally accepted
Jinhu Chen1*
Zhen-Rong Yang2Zhi-Ming Cai2Tao Lin2Ren Lin2Xin-Cheng Su2
Rongbin Kang Rongbin Kang2Lu Lin2
Ye Zai Sheng1Yong-Jian Zhou2- 1Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- 2Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Background: In 2009, the American Joint Commission on Cancer incorporated the gastrointestinal stromal tumours (GISTs) risk classification into the tumour, node, metastasis (TNM) staging system. We aimed to evaluate the prognostic value of the TNM staging system for GISTs by directly comparing it with the modified National Institutes of Health (NIH) criteria.Materials and Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2019) to retrospectively analyse patients with gastric and small intestinal/colorectal GISTs. Multivariate Cox regression analysis was performed to identify independent prognostic factors for cancer-specific survival (CSS). To assess the predictive performance of the TNM staging system and the modified NIH criteria, we calculated the area under the receiver operating characteristic curve (AUC), concordance index (C-index), Akaike information criterion (AIC), and Bayesian information criterion (BIC).Results: Of the 3,034 patients included, 2,106 had gastric GISTs and 928 had small intestinal/colorectal GISTs. Multivariate Cox analysis revealed that TNM stage was an independent prognostic factor for CSS. According to the modified NIH criteria, both the overall and subgroup cohorts exhibited better CSS in the low-risk group than that in the very low-risk group. In contrast, for the TNM staging system, the difference in CSS between stages IIIA and IIIB were not statistically significant (all P>0.05). Notably, only 2 of the 928 patients with small intestinal/colorectal GISTs met the modified NIH criteria for intermediate risk. In the gastric GISTs cohort, the AUC, C-index, AIC, and BIC values for the TNM staging system and the modified NIH criteria were similar. However, in the small intestine and colorectal GISTs cohort, the TNM staging system demonstrated better discriminatory performance with higher AUC and C-index and lower AIC and BIC values compared with the modified NIH criteria.Conclusions: Regarding prognostic evaluation, the TNM staging system was comparable to the modified NIH criteria for patients with gastric GISTs, but it outperformed the modified NIH criteria in the prediction of outcomes for patients with small intestine and colorectal GISTs.
Keywords: Gastrointestinal Stromal Tumours, National Institutes of Health (NIH) criteria, TNM staging system, Cancer-specific survival, Prognostic model
Received: 04 May 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Chen, Yang, Cai, Lin, Lin, Su, Rongbin Kang, Lin, Sheng and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jinhu Chen, Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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